OBJECTIVES: This is a collaborative epidemiologic study of lung cancer patient care and survival in New Hampshire and Vermont. The study is designed to determine whether geographic variations in patient care in this rural area are related to the local availability of specialized cancer treatment facilities and whether this can account for geographic differences in survival. The study will allow us to examine one of the basic assumptions underlying cancer control programs, i.e., that identifiable populations in the U.S. lack easy access to sophisticated cancer treatment facilities and therefore receive sub-optimal care with resultant poor outcome. APPROACH: The two-state population-based tumor registry has been used as a source of identified cases and we are conducting reviews of medical records to determine patient characteristics, functional status, tumor stage, and detailed treatment information. An independent slide review will provide information on histology. These data will be analyzed using univariate and multivariate methods to examine the effects of residence (i.e., distance from specialized treatment facilities) upon treatment received and length of survival. The analysis of survival times will necessitate adjustment for stage at diagnosis and other sources of bias.